If you visit a pain clinic and explain that you’re experiencing severe, constant pain that’s impacting your daily life despite being on a significant dose of opioids, it could be a sign that opioids aren’t the right treatment for you.
If those opioids aren’t effectively controlling your pain, this is referred to as "opioid unresponsive pain." A common reason for this unresponsiveness is that the pain is neuropathic in nature, meaning it originates from the nerves and is not well-treated by opioids.
In the past, the solution would have been to increase the dose, sometimes doubling or even quadrupling it. However, we now know that doing so doesn't make the pain opioid responsive. Instead, it leads to dangerous side effects, including respiratory depression, which can have fatal consequences.
Today, the approach is quite different. If opioids aren’t working for you, we look at slowly reducing the dose rather than increasing it. Surprisingly, in 80-90% of cases, patients experience no increase in pain as the dose is reduced. In fact, they often notice improvements in side effects like constipation, nausea, tiredness, and sleep issues. By lowering the opioid dosage, we can explore combining other medications that may be more effective in managing your pain.
In some cases, patients are able to completely stop taking opioids without any change in their pain levels, indicating that the opioids weren’t providing any real benefit to begin with. This can be difficult to understand, especially when you feel more pain or irritability towards the end of a dose. However, what’s actually happening is the beginning of withdrawal symptoms, not a resurgence of your original pain. This can give the false impression that the opioid is still helping, when in reality, it may not be.
The main point here is that it’s really important to have an open and honest conversation with your pain specialist. This way, you can figure out if opioids are actually doing what they’re supposed to or not. If they aren’t, your specialist can help you work out a gradual reduction plan that keeps side effects to a minimum. This approach gives you the chance to see how you feel on lower doses and find the best way to manage your pain, improve how you function, and boost your overall quality of life.
If you have any questions, please contact us at: https://hunterpainspecialists.com.au/contact